Pathology of Glomerular Disease

Question 1

what is a podocyte

Answer 1

a cell in the bowman’s capsule that wraps around the capillaries

Question 2

proteins equal to and bigger/smaller than albumin will not be filtered at glomerulus

Answer 2

bigger

Question 3

layer that capillary endothelium lies on

Answer 3

basal lamina

Question 4

3 layers of glomerular membrane

Answer 4

endothelium, basal lamina and podocyte foot process

Question 5

what is a podocyte foot process

Answer 5

a projections of the podocyte cell that wrap around the capillary and leave slits between

Question 6

what are mesangial cells

Answer 6

group of cells which support capillaries

Question 7

what do the mesangial cells make up

Answer 7

the mesangium

Question 8

glomerulonephritis is inflammatory/non-inflammatory

Answer 8

can be either

Question 9

some glomerulonephritis can be due to the deposition of

Answer 9

immunoglobulins

Question 10

what is glomerulonephritis

Answer 10

a large range of diseases of the glomerulus

Question 11

someone presents with discoloured urine with dipsticks positive for blood. What investigations should be done

Answer 11

urine culture and ultrasound, then biopsy if nothing found

Question 12

how does IgA deposition cause nephropathy

Answer 12

IgA clogs the mesangium –> irritates the cells –> causes them to proliferate –> excess mesangial cells

Question 13

IgA nephropathy is inflammatory/non-inflammatory

Answer 13

inflammatory

Question 14

presentation of IgA nephropathy

Answer 14

• blood in urine
• flank pain
• hand/feet oedema
• hypertension

Question 15

outcomes of IgA nephropathy

Answer 15

usually self-limiting and resolves

small amount of continued deposition –> glomerulus becomes more sclerosed –> chronic renal failure

Question 16

in membranous glomerulonephritis where does IgG get stuck

Answer 16

between basal lamina and podocyte of glomerulus

Question 17

pathophysiology of membranous glomerulonephritis

Answer 17

IgG accumulates between basal lamina and podocyte –> activates C3 (complement) –> punches a hole in filter –> leaky filter lets albumin through –> nephrotic syndrome

Question 18

what would you expect to find in a blood test for membranous glomerulonephritis

Answer 18

low serum albumin

Question 19

what would you expect in urine of membranous glomerulonephritis

Answer 19

high albumin in urine (proteinuria)

Question 20

what is the membrane like in membranous glomerulonephritis

Answer 20

thickened and leaky

Question 21

what causes IgG production and accumulation in membranous

Answer 21

essentially unknown - can be malignancy

Question 22

presentation of membranous glomerulonephritis

Answer 22

proteinuria, feeling unwell, ankle and leg oedema, low serum albumin, weight gain

Question 23

why do a clotting screen before a renal biopsy

Answer 23

because bleeding is a big risk of a kidney biopsy so you want to make sure this isn’t likely

Question 24

pathophysiology of diabetic nephropathy

Answer 24

high blood glucose –> glycated molecules –> deposition in basal lamina and mesangial matrix –> thickened and leaky membrane and mesangium compressing capillaries

Question 25

consequence of diabetic neuropathy on glomerular circulation

Answer 25

compressed capillaries and thickened, narrowed arterioles –>

Question 26

name given to excess growth of mesangial matrix in diabetic nephropathy

Answer 26

nodules - kimmelsteil-wilson lesion

Question 27

expected findings of blood test in diabetic nephropathy

Answer 27

low albumin (all leaking into urine)

Question 28

rapidly rising creatinine is a sign of what

Answer 28

acute renal failure

Question 29

what investigations would you do in suspected acute renal failure (rapidly rising creatinine)

Answer 29

ultrasound and renal biopsy

Question 30

histology of crescentic glomerulonephrititis

Answer 30

influx of macrophages forming crescent around glomerulus

Question 31

what is wegeners

Answer 31

a type of vasculitis which affects kidnyes, nose and lungs

in kidnyes it presents as crescentic glomerulonephritis

Question 32

tests for wegeners

Answer 32

serum test for anti neutrophil cytoplasmic antibodies (ANCA)

Question 33

what are anti-neutrophil cytoplasmic antibodies

Answer 33

antibodies directed against proteinase 3 and myeloperoxidase (enzymes in primary granules of neutrophils)

Question 34

effect of ANCA on kidneys

Answer 34

damage endothelial tissue